Value of Universal Cystoscopy Still not Determined

Almost everybody agrees that a cystoscopy should be performed after surgery for prolapse or incontinence, but this year’s John I. Brewer Lecture will consider the value of performing the procedure after hysterectomy performed with reconstructive surgery.

Lisa M. Peacock, MD

The debate “Routine Cystoscopy at the Time of Hysterectomy” will take place at 9:25 am today in Hall D and features Lisa M. Peacock, MD, chair and division director of Female Pelvic Medicine and Reconstructive Surgery in the department of obstetrics & gynecology and urology at LSU Health Sciences Center in New Orleans, and Rebecca Rogers, MD, associate chair for Clinical Integrations and Operations, department of women’s health at the Dell Medical School at the University of Texas at Austin. Drs. Rogers and Peacock will compare the strengths, limitations, and risks of universal and selective cystoscopy, including the potential cost implications.

Dr. Peacock will argue for routine cystoscopy at the time of hysterectomy, supporting the stance that early detection of urinary track injuries is in the best interest of patient care and that cystoscopy should be routinely performed following hysterectomy.

Cystoscopy in the operating room allows for early intervention and treatment, which reduces morbidity, mortality, and expense while alleviating patient anxiety, depression, pain, impacts to quality of life, and loss of employment that can occur when recognition of the injury is delayed.

Unlike decades ago, when most ob-gyns had to fight for cystoscopy privileges, the procedure is now a mandated expectation of resident training.

“It’s simple, easy-to-train, and now required by the Accreditation Council for Graduate Medical Education for residents to have a minimum number of cystoscopies,” Dr. Peacock said. “And in many of these cases, they are doing laparoscopic or robotic procedures where the video equipment is already present and available for use. It’s a very low-impact, safe procedure that can detect a pretty morbid injury.”

Rebecca Rogers, MD

Dr. Rogers said that while everybody pretty much agrees that a cystoscopy is warranted when doing any pelvic reconstruction surgery, some of the research and literature she expects to share during the debate helps indicate where the line at which the procedure becomes cost-effective lies.

“I’m on the con side, but I would interpret with caveats,” she said. “Does everybody need it? Probably not. But where we’re at on that continuum, I think, is under some debate.”

When most people frame this discussion, Dr. Rogers said, it’s economized into urogynecology versus non-urogynecology and doesn’t include peripartum hysterectomy or hysterectomy for malignant indications, for example. Like all guidelines, Dr. Rogers said, there must be some cognitive input into the interpretation and application.